PRSB Standard Implementation Toolkits
These implementation toolkits are designed to support you and your team to successfully embed PRSB standards in your organisations. The PRSB standards implementation process uses an iterative change cycle to embed organisational change.
Introduction
These implementation toolkits have been developed to help you through the adoption and implementation of the various PRSB information standards as part of meeting the broader digital transformation agenda. The toolkits will help to improve the delivery of care through the sharing and receiving of standardised health and care information.
Information standards exist to improve the safety and quality of health and social care, specifically to ensure that the right information is recorded correctly, in the right place, and can be accessed easily, by any authorised person who needs it, wherever they are.
The implementation toolkit has 5 sections which takes you through the different stages of service transformation as shown in Figure 1 (below). As PRSB standard implementation is an iterative process, the 5 stage cycle can be repeated any number of times until the required change is in place.
The toolkits include detailed resources to assist you with specific aspects of the change and transformation required to implement the PRSB Standards. Using these resources will help you plan, build support and engage effectively with key stakeholders as you implement the standards to provide high-quality and personalised care, and improve the experience for the patient, their carer, and their families.
Explore the project implementation diagram below to gain a better understanding of the PRSB standards implementation process.
Figure 1. Project Implementation: An Iterative Change Cycle
Who can use these toolkits?
These toolkits will help health and care professionals engage with the implementation of information standards and embrace organisational and system change. This will enable the sharing of approved standard information across health and care systems supporting the holistic care of individuals.
It will also help:
• Transformational Leads
• Project/Programme managers
• Commissioners
• Clinicians
How to start a transformation journey
Different organisations will start from different places – some will start their transformation process from a philosophical and cultural position whilst others will start with detailed consideration of their technical infrastructure requirements. It doesn’t matter where you start your journey as long as you consider the following recommendations in your transformation planning.
We recommend you:
- Consider the diagram FIGURE 1 (right) as your starting point for developing a road map for your own project.
- Review the list of resources and identify which are most relevant to your implementation project
- Make sure your project is:
– Aligned with the national transformation agenda and your local priorities
– Underpinned by a sound understanding of change and transformation processes - Undertake a stocktake
- Identify where you are in the planning/implementation cycle
- Dive into the relevant sections of the Toolkit that your stocktake and stakeholder analysis indicate you need to focus on.
Figure 1. Project Implementation: An Iterative Change Cycle
1. GETTING READY: SETTING THE VISION
Creating a local vision for change
The first step in designing the roadmap for change is to build it on a series of secure foundations:
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A local vision
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Defined leadership and sponsorship
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Build a guiding coalition
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Starting with the end in mind
If this change is going to be successful, everyone must understand the purpose of the change and the end result. This works best when the change is framed in the form of a compelling narrative, that connects with people emotionally and intellectually. Understanding your stakeholders and how the project will benefit them will help you develop your own local narrative. The stakeholder analysis will also help you identify the people you need to actively engage with to make your project successful. Successful stakeholder engagement ensures an effective and strong guiding coalition who are willing to work collaboratively.
Testing your local vision - do you have an agreed narrative?
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Does the narrative speak to key parts of the local community? (service users, families and professionals working in mental health)
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Do you have local leaders who can make the case for change?
Building a team
For the change to be successful you will need to build a team who can lead it. This team will ultimately report to sponsors and SROs for the transformation. Ideally, this team should include people with credibility who are recognised by members of the wider community whose practice will be affected as the new ways of working are implemented.
You might find it useful to address these questions through your own stocktake (stocktake is covered further down the page in the Getting Going section):
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Who is your team?
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How are the views of service users, families, and those who represent them represented with the guiding coalition?
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How is this team linked to the broader authorising environment of the ICS and its constituent organisations for the purposes of accountability and support?
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What resource, in terms of general management, digital expertise, project management, and expertise in the design of programmes of change will be dedicated to this project?
2. GETTING STARTED: PLANNING THE CHANGE
Planning the change and transformation process
Any transformation planning must answer the following fundamental questions, as a minimum:
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Where are we now, what is the “as is” state?
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Where are we trying to get to, what is the “to be” state?
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How are we going to get there?
Starting with the end in mind
The ultimate purpose of a transformation project is to deliver a range of positive outcomes for service users, avoid negative outcomes, and provide a better experience for both service users and the professionals who care for them. It is important that each system agrees outcomes which are of most significance in their setting. Needs and baseline levels of performance vary widely, reflecting the very different demography and epidemiology of the different populations they serve. Levels of attainment that would be regarded as routine in one setting would be unrealistic and lead to demotivation, in another.
Ownership of the framework of outcomes to be delivered is also a crucial part of building the will for change and maintaining energy and discretionary effort. A series of outcomes couched as a commitment, made by people who lead and deliver care, to the community that they serve, is a much more effective frame for these measures than meeting a national target.
Consider the table of dimensions of outcomes highlighting the potential impact and measures.
The transformation change will need to be piloted in different parts of the system. These might be geographies, specific services, Primary Care Networks, or others. Read more about developing and rolling out a pilot here.
When planning the pilot, consider answering
the following questions...
• What is your choice of initial pilots and why?
• What is your outline plan for adoption and spread?
• Who will you engage from beyond the initial pilots as ambassadors for subsequent waves of adoption and how will you engage them?
You may find the following links useful in thinking about how you evaluate and monitor change:
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Measurement for Improvement (YouTube)Measurement for Improvement (YouTube)
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Leading Large Scale Change: A practical guide (nhs.uk)Leading Large Scale Change: A practical guide (nhs.uk)
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Thinking Differently (nhs.uk)Thinking Differently (nhs.uk)
Stakeholder Analysis
Stakeholder analysis at the start of the project will help you in writing your business case. To engage people you need to understand them and their motivations. For the PRSB Standards implementation, you also need to understand who you need and why, and how important their positive involvement will be to your success. The key stakeholders mainly fall in the following three groups;
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You need senior support to secure necessary funding and resources, to align the implementation project with other key strategies, and you need their leverage and influence to secure the more active input of others.
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You need the active participation of health and social care professionals to fully understand the scale of the transformation you are undertaking, to gain access to all the informal information exchange channels that already exist, and ultimately to enact the practice changes necessary for the implementation to be achieved.
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You need the engagement of service users, careers and community volunteers to fully understand how they feel about the care planning information you gather and share, their confidence in the technology and data security, and to check assumptions about the adoption of technology.
Stakeholder Analysis Grid
The ‘stakeholder analysis grid’, available on the resources page, provides a useful template and enables you to capture intelligence about the various individuals and groups you want or need to engage during and beyond your project implementation.
Benefits planning and evaluation
There is a strong metrics culture in health policy and practice so you will also want to think about the quantitative data you use to demonstrate the benefits of your project.
The ‘benefits evaluation grid’ available on the resources page, prompts you to consider what measurements and evidence will be most relevant to your context and help you evidence the positive impact of your project. You can integrate this with your stakeholder analysis.
You also need to understand who you need and why, and how important their positive involvement will be to your success.
Developing a Business Case
It is best practice for any project to be justified in terms of a business case balancing the investment required against the planned outcomes.
3. GETTING GOING: Designing & Conducting a Stocktake
What is a stocktake?
Stocktake is an essential element for change and transformation. The stocktake provides an excellent vehicle for engaging everyone you need to support a successful implementation project and create a shared vision of the ‘to be’ aspiration. It builds on the stakeholder analysis already undertaken earlier and is critical in engaging the wider community of stakeholders. Through the stocktake you will undertake a deep dive into the reality of where your organisation is in relation to your practices and processes, relationships and connections, information, and systems. The consideration of systems requirements and configuration will involve your system vendors and technical infrastructure support colleagues as well as other stakeholders.
As you unearth more learning about your ‘as is’ situation you may need to revise your project assumptions and go through more cycles of stocktake to achieve a full picture and engage all the relevant stakeholders. Some of what you discover will be uncomfortable and challenge your assumptions about the scale of the change required.
Why conduct a stocktake?
Whilst the stocktake is invaluable in understanding the human, behavioural and practice-based aspects of the ‘as is’ state, it must be acknowledged that the socio-cultural stocktake is not a substitute for detailed technical mapping by specialist data analysts. Significant resource would need to be committed to dedicated data analysis to support transformation initiatives in their areas.
4. Getting people onboard: Engaging stakeholders and developing people
Introduction
Stakeholder engagement and people development are key elements of successful culture change, arguably one of the hardest elements of any transformation initiative.
To engage people you need to understand them and their motivations. You also need to understand who you need and why, and how important their positive involvement will be to your success. You will already have a good understanding of your stakeholders from the stakeholder analysis performed in the previous section.
In the context of PRSB standard implementation there are challenges associated with:
• Achieving buy-in that adopting/implementing the standard is a high priority
• Accepting that health and care professionals have developed numerous and ingenious ways of circumventing and subverting information systems they find frustrating, and you need to unearth these to get a full picture of your ‘as is’ position
• That service user groups are diverse and have a wide range of concerns about potentially invasive technology which you will need to understand to achieve wide-spread acceptance of shared care plans and planning
• Professionals and stakeholders are often seriously time-poor and reluctant to dedicate time to ‘non-clinical’ user-focused activities, so your engagement and people development activities have to be well designed and focus on how the outputs will benefit service users, health and social care professionals, and other stakeholders.
Developing People
Combining stakeholder engagement with people development and learning is a key factor in the successful implementation of PRSB standards.
A conservative ‘training’ model is often poorly suited to conveying values-based topics or addressing transformation projects requiring widespread culture change. A “how to” training approach is also ineffective as it did not engage participants and stakeholders in a deeper reflection about the topic and about their personal agency in addressing specific circumstances they experience in their work.
The most effective way of achieving radical transformation is through successive iterations of discussion based interdisciplinary group workshops. This approach lends itself to the PRSB Standards implementation because there are many different professional and stakeholder groups involved. Overall transformation requires policy, practice, culture and technology changes to occur.
Engeström’s expansive learning cycle of learning actions explains how there are 7 stages of learning actions. Click the button below to explore Engeström’s learning cycle further.
How people learn and work
Understanding how people learn and work is important as this might influence the formats you use to present information, the type of activities you design into workshops, and even the type of language you use in discussions.
Reflecting on your own learning and working styles preferences could also improve your own effectiveness and efficiency – do you prefer to receive information in visual, written, or audio form? Are you a ‘go faster’ or a ‘get it right’ person and does this affect how others work with you?
By understanding where you and where your audience are coming from you can achieve a better shared understanding of the agenda more quickly, and potentially get people far more engaged. You can aid learning by either presenting materials in formats that people are comfortable with or creatively using less comfortable learning to stimulate fresh insight.
If you want to explore learning styles further, the following links are a good place to start:
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Learning styles overviewLearning styles overview
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Honey and Mumford learning stylesHoney and Mumford learning styles
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VARK learning preferencesVARK learning preferences
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Working style driversWorking style drivers
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Forming a teamForming a team
Stakeholder engagement and learning models
In the stocktake guide we recommended a number of approaches to maintain momentum towards successful implementation and embedding of the PRSB standards and the associated policy, practice, culture and technology agendas.
These include:
• Action Learning Sets
• Communities of Practice
• Coaching/Mentoring
A number of other tools are used to improve the interactivity of your face-to-face and virtual workshops and consultations. These tools foster engagement and ownership by participants. These platforms also enable you to continue collecting feedback after the session and can function as a reference resource later such as Padlet, a web-based collaborative tool to drive your Stocktake workshops and to collect contributions from participants. Other similar tools include Mentimeter, Poll Everywhere, and Dotstorming.
5. Getting it done
Completing each stage of the implementation cycle
You are at the final implementation stage which means in order to have got to this stage of the process you must have completed each of the above stages. However, long lasting transformational change requires an iterative approach rather than a simple linear approach. In order to understand how progress is being made on all fronts, the project team will need to review, evaluate and iterate continually throughout the process. Continual iteration until completion at each stage will result in you ‘getting it done’.
Figure 1. Project Implementation: An Iterative Change Cycle
